Pediatric Stroke and Congenital Heart Disease
Pediatric heart stroke can happen in infants, children and even before birth. Signs are often missed in children because there is a lack of awareness that strokes can happen in this age group.
It’s important to work with your Pedatrician for prompt diagnosis and treatment of stroke in children. A stroke is caused by the interruption of normal flow of blood to the brain, either by a blockage or a rupture in the blood vessels. When a part of the brain doesn’t receive its regular flow of blood that carries vital nutrients and oxygen, brain cells die, causing a loss of brain function.
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The age of the child at the time of stroke makes a difference in how doctors identify and treat the problem. Stroke can occur in these three different age groups:
• The prenatal phase, or in the womb.
• The first 28 days of life, or newborn phase.
• From the infant years up to 18 years of age.
The area of the brain where the stroke takes place will determine the extent of the damage and the after-effects.
Children may experience two types of stroke: hemorrhagic stroke (rupture of blood vessels), or ischemic stroke (blockage caused by a blood clot).
Causes of stroke in children: The reasons why stroke occurs in children are varied and include malformations of the blood vessels and rare diseases.
Hemorrhagic stroke occurs when a blood vessel ruptures in the brain. If an artery wall is weak, blood can collect in the wall causing it to balloon (aneurysm). If the pressure builds, the aneurysm can rupture and damage the brain either by flooding at the leakage site or by shortage of blood supply beyond the leakage.
Hemorrhagic stroke in children
The causes of hemorrhagic stroke in children include:
• An artery malformation or disorder.
• A brain tumour.
• In rare cases, drug or alcohol abuse by the mother.
Ischemic stroke is usually caused by a blood clot in the brain. The leading risk factors for ischemic stroke in children include:
• Heart disease. When children are born with a heart defect (congenital heart disease), their risk of having a stroke is increased. Heart disease, such as rheumatic heart disease, can also be acquired later in childhood. Stroke is not usually the first sign of heart disease. Often heart disease has been diagnosed before the child has a stroke.
• Blood-clotting disorders, also known as prothrombotic disorders, cause the blood to thicken and clot faster. These disorders can be present at birth or acquired later on. A child can be born with a genetic mutation that makes the blood clot faster. Stroke is often the first sign of a blood-clotting disorder. Some illnesses, such as meningitis, sepsis, diarrhea, dehydration or an iron deficiency, can also lead to blood clotting abnormalities.
• Irregular arteries. A child can have a stroke because the arteries in the brain are irregular or narrowed. This is called arteriopathy. When children are born with this problem, it often goes undetected until a stroke occurs. Children with irregular arteries need to be monitored closely by their stroke clinic team because they are at a higher risk of experiencing another stroke.
Other risk factors. Children are also at higher risk of having a stroke if they have any of the following risk factors:
• heart or brain surgery
• sickle cell disease
• autoimmune disease that attacks arteries in the brain
• trauma to the brain or neck
• Some pediatric stroke cases have no known cause.
Diagnosis of stroke in children
A quick diagnosis is important to minimize risk for brain damage. Doctors rely on imaging machines and other tests to see what has happened in a child’s brain.
• Computed tomography (CT) scan uses X-rays to take a detailed picture of the affected area of the brain. A CT scan will confirm whether or not the child has had a stroke, what kind of stroke it is and where in the brain it occurred.
• Magnetic resonance imaging (MRI) uses magnetic radio waves to create an image of the brain. It provides greater visual details than a CT scan.
• Cerebral arteriogram uses a special dye injected into the arteries of the brain and an X-ray is then taken.
• Echocardiogram uses sound waves to take pictures of the heart to see whether there are problems with the heart valves or other heart functions that may be creating blood clots.
• Electrocardiogram (ECG or EKG) measures the heart's electrical activity and any problems with heart rate or rhythm.
• Blood tests may also be ordered to find out whether your child has a blood-clotting disorder.
• Lumbar puncture (also known as a spinal tap) is performed to find out if there are signs of infection or inflammation in the nervous system.